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input.radio{display:inline!important;float:none!important;}.af-element-radio.inline{float:left;margin-left:0;margin-right:7px;}.af-element.radio{display:block!important;}.af-element{padding:5px 0;}.af-form-wrapper{text-indent:0;}.af-form{text-align:left;margin:auto;}.af-header,.af-footer{margin-bottom:0;margin-top:0;padding:10px;}.af-quirksMode .af-element{padding-left:0!important;padding-right:0!important;}.af-usaddress input{margin-bottom:5px;}.af-usaddress{padding:6px 0;}.choiceList-radio-inline .af-element-radio{float:left;}.lbl-right .af-element label{text-align:right;}body {}</style><form method=\"post\" class=\"af-form-wrapper\" action=\"http://www.aweber.com/scripts/addlead.pl\" target=\"_new\" ><div style=\"display: none;\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"144093797\" /><input type=\"hidden\" name=\"meta_split_id\" value=\"\" /><input type=\"hidden\" name=\"listname\" value=\"fbsurvey2010\" /><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=video\" id=\"redirect_ef340a946e44499f715626e4c2a63cee\" /><input type=\"hidden\" name=\"meta_adtracking\" value=\"Online_Survey\" /><input type=\"hidden\" name=\"meta_message\" value=\"1\" /><input type=\"hidden\" name=\"meta_required\" value=\"name,email,custom US Address (Street 1),custom US Address (City),custom US Address (State),custom US Address (ZIP Code)\" /><input type=\"hidden\" name=\"meta_tooltip\" value=\"\" /></div><div id=\"af-form-144093797\" class=\"af-form\"><div id=\"af-header-144093797\" class=\"af-header\"><div class=\"bodyText\"><p style=\"text-align: left;\"><strong>Take Our Public Health Survey Online! Get your Free \"Guide to Better Health\" and we will also send some free sample of our Fruits and Veggies Gummys (chewables), great for kids.&nbsp;</strong></p></div></div><div id=\"af-body-144093797\" class=\"af-body af-standards\"><div class=\"af-element\" style=\"text-align: left;\"><img src=\"http://i636.photobucket.com/albums/uu83/coachsuccess/JPGardenandorchard-1.jpg\" alt=\"New Graphic\" /><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335829\">Name: </label><div class=\"af-textWrap\"><input id=\"awf_field-7335829\" type=\"text\" name=\"name\" class=\"text\" value=\"\"  tabindex=\"500\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335812\">Email: </label><div class=\"af-textWrap\"><input class=\"text\" id=\"awf_field-7335812\" type=\"text\" name=\"email\" value=\"\" tabindex=\"501\"  /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335824\">Phone:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-7335824\" class=\"text\" name=\"custom Phone\" value=''  tabindex=\"502\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335815street1\">Street:</label><div class=\"af-textWrap\"><input id=\"awf_field-7335815street1\" type=\"text\" class=\"text\" name=\"custom US Address (Street 1)\" tabindex=\"503\" /></div> <div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335815city\">City:</label><div class=\"af-textWrap\"><input id=\"awf_field-7335815city\" type=\"text\" class=\"text\" name=\"custom US Address (City)\" tabindex=\"504\" /></div> <div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335815state\">State:</label><div class=\"af-selectWrap\"><select id=\"awf_field-7335815state\" name=\"custom US Address (State)\" tabindex=\"505\" > <option value=\"\"></option><option value=\"AL\">AL</option><option value=\"AK\">AK</option><option value=\"AZ\">AZ</option><option value=\"AR\">AR</option><option value=\"CA\">CA</option><option value=\"CO\">CO</option><option value=\"CT\">CT</option><option value=\"DC\">DC</option><option value=\"DE\">DE</option><option value=\"FL\">FL</option><option value=\"GA\">GA</option><option value=\"HI\">HI</option><option value=\"ID\">ID</option><option value=\"IL\">IL</option><option value=\"IN\">IN</option><option value=\"IA\">IA</option><option value=\"KS\">KS</option><option value=\"KY\">KY</option><option value=\"LA\">LA</option><option value=\"ME\">ME</option><option value=\"MD\">MD</option><option value=\"MA\">MA</option><option value=\"MI\">MI</option><option value=\"MN\">MN</option><option value=\"MS\">MS</option><option value=\"MO\">MO</option><option value=\"MT\">MT</option><option value=\"NE\">NE</option><option value=\"NV\">NV</option><option value=\"NH\">NH</option><option value=\"NJ\">NJ</option><option value=\"NM\">NM</option><option value=\"NY\">NY</option><option value=\"NC\">NC</option><option value=\"ND\">ND</option><option value=\"OH\">OH</option><option value=\"OK\">OK</option><option value=\"OR\">OR</option><option value=\"PA\">PA</option><option value=\"PR\">PR</option><option value=\"RI\">RI</option><option value=\"SC\">SC</option><option value=\"SD\">SD</option><option value=\"TN\">TN</option><option value=\"TX\">TX</option><option value=\"UT\">UT</option><option value=\"VT\">VT</option><option value=\"VA\">VA</option><option value=\"WA\">WA</option><option value=\"WV\">WV</option><option value=\"WI\">WI</option><option value=\"WY\">WY</option></select></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335815zip\">ZIP Code:</label><div class=\"af-textWrap\"><input id=\"awf_field-7335815zip\" type=\"text\" class=\"text\" name=\"custom US Address (ZIP Code)\" tabindex=\"506\" /></div> <div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"\">Health :</label><div class=\"choiceList choiceList-radio-stacked\"></div></div><div class=\"af-clear\"></div></div><div class=\"af-element af-element-checkbox\"><div class=\"af-checkWrap\"><input type=\"checkbox\" value=\"yes\" id=\"awf_field-7335819\" class=\"checkbox\"  name=\"custom Poor\" tabindex=\"507\" /> <label class=\"choice\" for=\"awf_field-7335819\">Poor:</label></div><div class=\"af-clear\"></div></div><div class=\"af-element af-element-checkbox\"><div class=\"af-checkWrap\"><input type=\"checkbox\" value=\"yes\" id=\"awf_field-7335828\" class=\"checkbox\"  name=\"custom Good\" tabindex=\"508\" /> <label class=\"choice\" for=\"awf_field-7335828\">Good:</label></div><div class=\"af-clear\"></div></div><div class=\"af-element af-element-checkbox\"><div class=\"af-checkWrap\"><input type=\"checkbox\" value=\"yes\" id=\"awf_field-7335820\" class=\"checkbox\"  name=\"custom Excellent\" tabindex=\"509\" /> <label class=\"choice\" for=\"awf_field-7335820\">Excellent :</label></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335830\">Do You Smoke:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-7335830\" class=\"text\" name=\"custom Do You Smoke\" value=''  tabindex=\"510\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335827\">Do you exercise:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-7335827\" class=\"text\" name=\"custom Do you exercise\" value=''  tabindex=\"511\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335814\">Do you Eat  Fruits and Veggies:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-7335814\" class=\"text\" name=\"custom Do you Get Fruits and Veggies\" value=''  tabindex=\"512\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335822\">Do you want to get more Fruits and Veggies in your diet:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-7335822\" class=\"text\" name=\"custom Do you want to get more Fruits and Veggies in your diet\" value=''  tabindex=\"513\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-7335818\">Send Me a Free Sample:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-7335818\" class=\"text\" name=\"custom Send Me a Free Sample\" value=''  tabindex=\"514\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\" style=\"text-align: Center;\"><img src=\"http://i636.photobucket.com/albums/uu83/coachsuccess/JPGardenandorchard-1.jpg\" alt=\"New Graphic\" /><div class=\"af-clear\"></div></div><div class=\"af-element buttonContainer\"><input name=\"submit\" class=\"submit\" type=\"submit\" value=\"Submit Survey\" tabindex=\"515\" /><div class=\"af-clear\"></div></div><div class=\"af-element privacyPolicy\" style=\"text-align: center\"><p><a title=\"Privacy Policy\" href=\"http://www.aweber.com/permission.htm\" target=\"_blank\">We respect your email privacy</a></p><div class=\"af-clear\"></div></div></div><div id=\"af-footer-144093797\" class=\"af-footer\"><div class=\"bodyText\"><p style=\"text-align: center;\"><em>Eat More Fruits and Veggies Today!&nbsp;</em></p></div></div></div></form><script type=\"text/javascript\">    <!--    (function() {        var IE = /*@cc_on!@*/false;        if (!IE) { return; }        if (document.compatMode && document.compatMode == 'BackCompat') {            if 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